![[smlogo graphic]](../images/smlogo.gif)
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Medical and Dental Coverage
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Sponsored by Global
Benefits Group
The SPE Global Care Insurance Program
offers SPE members and their
families a comprehensive major medical plan that comprises 3
types of coverage: Independence
Worldwide, Independence
International, and
Independence International Plus. (This plan is not
available to U.S. citizens.)
In addition, any SPE member covered by an individual policy issued by
Global Benefits Group is eligible to purchase a supplemental
package with a life insurance and dental benefit (see
Premier Benefits Package explanations below).
Permanent residents of the
US,
Canada,
Hong Kong, United
Kingdom, and
Switzerland
cannot be covered. Please contact us at
geocare@rutherfoord.com for further details.
Three Types of Coverage to Choose From
Independence
Worldwide Plan
Coverage has no geographic
restrictions.
Independence
International and International Plus
Treatment under International
and International Plus policies is subject
to restrictions in certain countries and/or facilities.
Treatment in the US
& Canada
is not covered for International
policyholders and is covered on an emergency only basis for
International Plus members.
International Plus members must receive
preauthorization prior to receiving coverage in a restricted
country.
What are the restricted
countries?
The following countries or areas have
policy restrictions. See details below.
- Canada
- Hong Kong
- Singapore
- Switzerland
- UK
- US
Independence
International Plan
US & Canada:
No coverage
U.K.,
Singapore, Hong Kong, and Switzerland:
Co-pay equal to 20% of the first $10,000 of
covered treatment, per person, per year.
Independence
International Plus
Plan
The Care Coordination Department must
be contacted and treatment must be approved in order to be
covered.
U.S. &
Canada: Emergency
coverage only.
U.K.,
Singapore, Hong Kong, and Switzerland:
20% Co-pay. Co-pay will be waived for Emergency
treatment (as defined in the policy).
Eligibility
You are eligible to purchase this
policy if you reside or travel more than 180 days outside of
your home country
You are eligible for coverage if you
have not attained age 65 at the time of enrollment. You may
renew your policy through age 72.
Your eligibility date, if you have been
determined eligible, will be the first day of the month
following the first day of acceptance.
You may renew your policy if you return
to a restricted area, to reside and/or work. The premium
will be calculated at the rates applicable to the restricted
areas.
Membership Card
In addition to this policy, members
receive a card detailing certain features of their coverage.
Your membership card will contain the following;
- Deductible amount - How to file a
claim
- Policy Number - Contact number in
case of emergency
- Co-payment percentage - How to
contact the preferred provider network
- Phone number for pre-authorization.
Application
Form
Annual Premiums
INDEPENDENCE
WORLDWIDE PLAN
(Includes coverage in the U.S. & Canada)
(but excludes permanent Residents of US,
Canada, Hong Kong, United Kingdom,
Switzerland)
|
|
Deductible
|
Coverage
|
Up to 29
|
30-34
|
35-39
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
over 64
|
|
|
Single
|
$3,269
|
$3,514
|
$4,243
|
$4,878
|
$5,853
|
$6,784
|
$8,058
|
$10,602
|
$14,842
|
|
|
SPF
|
$5,574
|
$5,988
|
$7,681
|
$8,317
|
$9,270
|
$10,224
|
$11,496
|
$14,041
|
$18,281
|
|
$0
|
Couple
|
$6,297
|
$6,768
|
$8,173
|
$9,399
|
$11,278
|
$13,072
|
$15,527
|
$20,429
|
$28,598
|
|
|
Family
|
$8,602
|
$9,243
|
$11,611
|
$12,837
|
$15,405
|
$16,512
|
$18,966
|
$23,868
|
$32,037
|
|
|
Single
|
$3,073
|
$3,302
|
$3,988
|
$4,585
|
$5,502
|
$6,378
|
$7,575
|
$9,967
|
$13,952
|
|
|
SPF
|
$5,239
|
$5,630
|
$7,220
|
$7,818
|
$8,715
|
$9,611
|
$10,807
|
$13,199
|
$17,184
|
|
$100
|
Couple
|
$5,920
|
$6,361
|
$7,681
|
$8,834
|
$10,601
|
$12,288
|
$14,596
|
$19,203
|
$26,882
|
|
|
Family
|
$8,086
|
$8,688
|
$10,914
|
$12,066
|
$14,480
|
$15,521
|
$17,828
|
$22,434
|
$30,113
|
|
|
Single
|
$2,943
|
$3,162
|
$3,818
|
$4,390
|
$5,268
|
$6,106
|
$7,253
|
$9,542
|
$13,359
|
|
|
SPF
|
$5,016
|
$5,390
|
$6,913
|
$7,486
|
$8,344
|
$9,202
|
$10,347
|
$12,637
|
$16,452
|
|
$250
|
Couple
|
$5,667
|
$6,091
|
$7,355
|
$8,459
|
$10,149
|
$11,766
|
$13,975
|
$18,386
|
$25,739
|
|
|
Family
|
$7,742
|
$8,320
|
$10,451
|
$11,553
|
$13,864
|
$14,861
|
$17,069
|
$21,481
|
$28,833
|
|
|
Single
|
$2,712
|
$2,916
|
$3,522
|
$4,048
|
$4,859
|
$5,632
|
$6,688
|
$8,800
|
$12,320
|
|
|
SPF
|
$4,626
|
$4,971
|
$6,376
|
$6,903
|
$7,695
|
$8,486
|
$9,542
|
$11,655
|
$15,172
|
|
$500
|
Couple
|
$5,227
|
$5,616
|
$6,783
|
$7,802
|
$9,360
|
$10,851
|
$12,889
|
$16,956
|
$23,737
|
|
|
Family
|
$7,140
|
$7,672
|
$9,638
|
$10,655
|
$12,786
|
$13,706
|
$15,742
|
$19,809
|
$26,591
|
|
|
Single
|
$2,451
|
$2,636
|
$3,183
|
$3,660
|
$4,390
|
$5,089
|
$6,045
|
$7,952
|
$11,132
|
|
|
SPF
|
$4,181
|
$4,492
|
$5,761
|
$6,238
|
$6,953
|
$7,669
|
$8,623
|
$10,531
|
$13,711
|
|
$1,000
|
Couple
|
$4,723
|
$5,075
|
$6,129
|
$7,049
|
$8,458
|
$9,806
|
$11,646
|
$15,322
|
$21,450
|
|
|
Family
|
$6,451
|
$6,932
|
$8,710
|
$9,629
|
$11,554
|
$12,384
|
$14,225
|
$17,901
|
$24,028
|
|
|
Single
|
$2,125
|
$2,284
|
$2,758
|
$3,172
|
$3,806
|
$4,411
|
$5,238
|
$6,892
|
$9,648
|
|
|
SPF
|
$3,622
|
$3,893
|
$4,993
|
$5,407
|
$6,026
|
$6,646
|
$7,472
|
$9,127
|
$11,883
|
|
$2,000
|
Couple
|
$4,094
|
$4,400
|
$5,312
|
$6,110
|
$7,330
|
$8,498
|
$10,094
|
$13,280
|
$18,590
|
|
|
Family
|
$5,592
|
$6,009
|
$7,548
|
$8,345
|
$10,014
|
$10,733
|
$12,328
|
$15,514
|
$20,824
|
|
|
Single
|
$1,602
|
$1,722
|
$2,080
|
$2,391
|
$2,868
|
$3,325
|
$3,950
|
$5,195
|
$7,273
|
|
|
SPF
|
$2,732
|
$2,935
|
$3,764
|
$4,076
|
$4,544
|
$5,010
|
$5,633
|
$6,881
|
$8,958
|
|
$5,000
|
Couple
|
$3,087
|
$3,317
|
$4,005
|
$4,607
|
$5,527
|
$6,407
|
$7,610
|
$10,011
|
$14,014
|
|
|
Family
|
$4,215
|
$4,529
|
$5,691
|
$6,291
|
$7,549
|
$8,093
|
$9,295
|
$11,695
|
$15,698
|
|
1.
SPF: Single Parent Family
2.
Max entry age 65,
renewal until 72
|
INDEPENDENCE
INTERNATIONAL PLAN
(Excludes
U.S. & Canada)
(and permanent residents of US, Canada, Hong Kong,
United Kingdom, Switzerland)
|
|
Deductible
|
Coverage
|
Up to 29
|
30-34
|
35-39
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
over 64
|
|
|
Single
|
$1,988
|
$2,136
|
$2,580
|
$2,966
|
$3,559
|
$4,125
|
$4,899
|
$6,445
|
$9,024
|
|
|
SPF
|
$3,049
|
$3,277
|
$4,166
|
$4,552
|
$5,185
|
$5,712
|
$6,485
|
$8,032
|
$10,609
|
|
$0
|
Couple,
|
$3,828
|
$4,114
|
$4,966
|
$5,713
|
$6,857
|
$7,949
|
$9,439
|
$12,417
|
$17,381
|
|
|
Family
|
$4,890
|
$5,256
|
$6,553
|
$7,299
|
$8,758
|
$9,533
|
$11,024
|
$14,001
|
$18,969
|
|
|
Single
|
$1,870
|
$2,008
|
$2,426
|
$2,788
|
$3,345
|
$3,877
|
$4,606
|
$6,059
|
$8,482
|
|
|
SPF
|
$2,866
|
$3,080
|
$3,918
|
$4,278
|
$4,874
|
$5,369
|
$6,096
|
$7,551
|
$9,972
|
|
$100
|
Couple,
|
$3,598
|
$3,868
|
$4,669
|
$5,371
|
$6,445
|
$7,471
|
$8,873
|
$11,672
|
$16,339
|
|
|
Family
|
$4,596
|
$4,942
|
$6,160
|
$6,862
|
$8,233
|
$8,961
|
$10,362
|
$13,163
|
$17,831
|
|
|
Single
|
$1,790
|
$1,923
|
$2,322
|
$2,671
|
$3,203
|
$3,713
|
$4,410
|
$5,802
|
$8,121
|
|
|
SPF
|
$2,745
|
$2,950
|
$3,750
|
$4,097
|
$4,667
|
$5,141
|
$5,837
|
$7,229
|
$9,548
|
|
$250
|
Couple,
|
$3,444
|
$3,702
|
$4,470
|
$5,142
|
$6,171
|
$7,153
|
$8,495
|
$11,176
|
$15,643
|
|
|
Family
|
$4,401
|
$4,731
|
$5,897
|
$6,570
|
$7,883
|
$8,580
|
$9,921
|
$12,602
|
$17,072
|
|
|
Single
|
$1,650
|
$1,774
|
$2,143
|
$2,463
|
$2,954
|
$3,424
|
$4,067
|
$5,350
|
$7,490
|
|
|
SPF
|
$2,531
|
$2,720
|
$3,458
|
$3,778
|
$4,304
|
$4,740
|
$5,382
|
$6,667
|
$8,805
|
|
$500
|
Couple,
|
$3,178
|
$3,415
|
$4,123
|
$4,742
|
$5,691
|
$6,598
|
$7,835
|
$10,307
|
$14,428
|
|
|
Family
|
$4,059
|
$4,362
|
$5,439
|
$6,059
|
$7,269
|
$7,914
|
$9,151
|
$11,622
|
$15,744
|
|
|
Single
|
$1,491
|
$1,603
|
$1,936
|
$2,224
|
$2,670
|
$3,094
|
$3,675
|
$4,834
|
$6,768
|
|
|
SPF
|
$2,288
|
$2,459
|
$3,125
|
$3,414
|
$3,889
|
$4,284
|
$4,864
|
$6,025
|
$7,957
|
|
$1,000
|
Couple,
|
$2,871
|
$3,086
|
$3,726
|
$4,286
|
$5,143
|
$5,961
|
$7,079
|
$9,314
|
$13,037
|
|
|
Family
|
$3,668
|
$3,942
|
$4,915
|
$5,474
|
$6,570
|
$7,151
|
$8,268
|
$10,501
|
$14,227
|
|
|
Single
|
$1,293
|
$1,389
|
$1,678
|
$1,929
|
$2,313
|
$2,682
|
$3,185
|
$4,190
|
$5,866
|
|
|
SPF
|
$1,984
|
$2,131
|
$2,708
|
$2,960
|
$3,372
|
$3,713
|
$4,215
|
$5,221
|
$6,896
|
|
$2,000
|
Couple,
|
$2,489
|
$2,674
|
$3,229
|
$3,714
|
$4,458
|
$5,166
|
$6,135
|
$8,071
|
$11,298
|
|
|
Family
|
$3,179
|
$3,417
|
$4,260
|
$4,746
|
$5,694
|
$6,198
|
$7,168
|
$9,102
|
$12,330
|
|
|
Single
|
$975
|
$1,047
|
$1,265
|
$1,454
|
$1,745
|
$2,022
|
$2,401
|
$3,159
|
$4,422
|
|
|
SPF
|
$1,496
|
$1,606
|
$2,042
|
$2,232
|
$2,541
|
$2,799
|
$3,178
|
$3,936
|
$5,200
|
|
$5,000
|
Couple,
|
$1,876
|
$2,016
|
$2,434
|
$2,800
|
$3,360
|
$3,895
|
$4,626
|
$6,086
|
$8,518
|
|
|
Family
|
$2,397
|
$2,576
|
$3,212
|
$3,578
|
$4,292
|
$4,672
|
$5,403
|
$6,862
|
$9,296
|
|
3.
SPF: Single Parent Family
4.
Max entry age 65,
renewal until 72
|
INDEPENDENCE
INTERNATIONAL PLUS PLAN
(In U.S.
&
Canada
Emergency Coverage Only)
(but excludes permanent Residents of US,
Canada, Hong Kong, United Kingdom,
Switzerland)
|
|
Deductible
|
Coverage
|
Up to 29
|
30-34
|
35-39
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
over 64
|
|
|
Single
|
$2,146
|
$2,294
|
$2,737
|
$3,124
|
$3,716
|
$4,282
|
$5,057
|
$6,603
|
$9,182
|
|
|
SPF
|
$3,248
|
$3,474
|
$4,364
|
$4,750
|
$5,383
|
$5,908
|
$6,683
|
$8,230
|
$10,807
|
|
$0
|
Couple,
|
$4,065
|
$4,350
|
$5,204
|
$5,951
|
$7,093
|
$8,185
|
$9,675
|
$12,654
|
$17,619
|
|
|
Family
|
$5,157
|
$5,520
|
$6,817
|
$7,564
|
$9,024
|
$9,799
|
$11,290
|
$14,269
|
$19,233
|
|
|
Single
|
$2,017
|
$2,156
|
$2,574
|
$2,936
|
$3,494
|
$4,025
|
$4,753
|
$6,206
|
$8,631
|
|
|
SPF
|
$3,053
|
$3,267
|
$4,102
|
$4,464
|
$5,060
|
$5,554
|
$6,282
|
$7,736
|
$10,159
|
|
$100
|
Couple,
|
$3,822
|
$4,089
|
$4,893
|
$5,593
|
$6,668
|
$7,695
|
$9,094
|
$11,895
|
$16,562
|
|
|
Family
|
$4,848
|
$5,189
|
$6,409
|
$7,111
|
$8,482
|
$9,210
|
$10,613
|
$13,412
|
$18,080
|
|
|
Single
|
$1,931
|
$2,065
|
$2,464
|
$2,811
|
$3,344
|
$3,855
|
$4,552
|
$5,942
|
$8,263
|
|
|
SPF
|
$2,923
|
$3,128
|
$3,928
|
$4,274
|
$4,845
|
$5,318
|
$6,015
|
$7,407
|
$9,726
|
|
$250
|
Couple,
|
$3,660
|
$3,915
|
$4,685
|
$5,355
|
$6,384
|
$7,368
|
$8,709
|
$11,388
|
$15,857
|
|